Seebacher Barbara, Kuisma Raija, Glynn Angela, Berger Thomas
1School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, BN20 7UR UK.
2Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Arch Physiother. 2018 Mar 2;8:6. doi: 10.1186/s40945-018-0045-0. eCollection 2018.
Motor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance. Our previous study results demonstrated significantly improved walking after rhythmic-cued MI in people with multiple sclerosis (pwMS). The present feasibility study was aimed to obtain preliminary information of changes in walking, fatigue, quality of life (QoL) and MI ability following cued and non-cued MI in pwMS. The study further investigated the feasibility of a larger study and examined the reliability of a two-dimensional gait analysis system.
At the MS-Clinic, Department of Neurology, Medical University of Innsbruck, Austria, 15 adult pwMS (1.5-4.5 on the Expanded Disability Status Scale, 13 females) were randomised to one of three groups: 24 sessions of 17 min of MI with music and verbal cueing (MVMI), with music alone (MMI), or non-cued (MI). Descriptive statistics were reported for all outcomes. Primary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test). Secondary outcomes were recruitment rate, retention, adherence, acceptability, adverse events, MI ability (Kinaesthetic and Visual Imagery Questionnaire, Time-Dependent MI test), fatigue (Modified Fatigue Impact Scale) and QoL (Multiple Sclerosis Impact Scale-29). The reliability of a gait analysis system used to assess gait synchronisation with music beat was tested.
Participants showed adequate MI abilities. Post-intervention, improvements in walking speed, walking distance, fatigue, QoL and MI ability were observed in all groups. Success of the feasibility criteria was demonstrated by recruitment and retention rates of 8.6% (95% confidence interval, CI 5.2, 13.8%) and 100% (95% CI 76.4, 100%), which exceeded the target rates of 5.7% and 80%. Additionally, the 83% (95% CI 0.42, 0.99) adherence rate surpassed the 67% target rate. Intra-rater reliability analysis of the gait measurement instruments demonstrated excellent Intra-Class Correlation coefficients for step length of 0.978 (95% CI 0.973, 0.982) and step time of 0.880 (95% CI 0.855, 0.902).
Results from our study suggest that cued and non-cued MI are valuable interventions in pwMS who were able to imagine movements. A larger study appears feasible, however, substantial improvements to the methods are required such as stratified randomisation using a computer-generated sequence and blinding of the assessors.
ISRCTN ISRCTN92351899. Registered 10 December 2015.
运动想象（MI）在神经康复中越来越多地被用于促进运动表现。我们之前的研究结果表明，多发性硬化症患者（pwMS）在有节奏提示的运动想象训练后，步行能力有显著改善。本可行性研究旨在获取pwMS患者在有提示和无提示的运动想象训练后，步行、疲劳、生活质量（QoL）和运动想象能力变化的初步信息。该研究进一步探讨了开展更大规模研究的可行性，并检验了二维步态分析系统的可靠性。
在奥地利因斯布鲁克医科大学神经病学系的多发性硬化症诊所，15名成年pwMS患者（扩展残疾状态量表评分为1.5 - 4.5，13名女性）被随机分为三组之一：24节时长17分钟的有音乐和言语提示的运动想象训练（MVMI）、仅有音乐的运动想象训练（MMI）或无提示的运动想象训练（MI）。报告了所有结果的描述性统计数据。主要结果是步行速度（25英尺定时步行）和步行距离（6分钟步行测试）。次要结果包括招募率、保留率、依从性、可接受性、不良事件、运动想象能力（动觉和视觉想象问卷、时间依赖性运动想象测试）、疲劳（改良疲劳影响量表）和生活质量（多发性硬化症影响量表 - 29）。测试了用于评估与音乐节拍同步步态的步态分析系统的可靠性。
参与者表现出足够的运动想象能力。干预后，所有组在步行速度、步行距离、疲劳、生活质量和运动想象能力方面均有改善。可行性标准的成功通过8.6%（95%置信区间，CI 5.2，13.8%）的招募率和100%（95% CI 76.4，100%）的保留率得以证明，这超过了5.7%和80%的目标率。此外，83%（95% CI 0.42，0.99）的依从率超过了67%的目标率。步态测量仪器的评分者内可靠性分析显示，步长的组内相关系数极佳，为0.978（95% CI 0.973，0.982），步时的组内相关系数为0.880（95% CI 0.855，0.902）。
我们的研究结果表明，有提示和无提示的运动想象训练对于能够想象运动的pwMS患者是有价值的干预措施。开展更大规模的研究似乎是可行的，然而，需要对方法进行实质性改进，例如使用计算机生成的序列进行分层随机化以及评估者设盲。
ISRCTN ISRCTN92351899。2015年12月10日注册。
